Background Preeclampsia (PE) is one of the main causes of medical complication of pregnancy and is the main cause of perinatal mortality and morbidity. It is one of the top causes of maternal mortality in Ethiopia. Also known as transient hypertension, gestational hypertension (GH) is increased blood pressure during pregnancy without proteinuria, which is expected to return to normal by the 12th-week postpartum visit. PE is GH with proteinuria and /or other systemic manifestations. Evidence from high income countries show that GH significantly progresses towards PE. To our knowledge, this is the first study on the progression of GH towards PE in an African setting. The objective of this study is, therefore, to assess the incidence of GH, progression towards PE and factors associated with progression in Ethiopia. Methods This is a prospective cohort study conducted at Ayder Comprehensive Specialized Hospital (ACSH) and Mekelle General Hospital (MGH), the largest referral centers in Northern Ethiopia. Two hundred and forty women with GH were enrolled and followed up until delivery. Clinical and laboratory data at initial presentation and at follow-up were compared among women who progressed towards PE and who remained with the diagnosis of GH. Logistic regression analysis was employed to model the combined effects of the clinical and laboratory data as significant predictors of progression from GH to PE. Result The incidence of GH in this study was 6 % (4.9–8.5). The rate of progression was 17.1 % (13.4–23.8). Previous history of GH, anemia during pregnancy, previous second-trimester spontaneous abortion were significant predictors of progression. Conclusions There is a high rate of progression of GH towards PE. In a resource-limited setting where predictive and diagnostic tools are scarce, clinical profile of women should be taken into consideration for prediction and diagnosis of PE.

INTRODUCTION: Preeclampsia is a common pregnancy disorder with potential adverse maternal and neonatal outcome. Ayder Referral Hospital (ARH), a tertiary hospital in northern Ethiopia where most preeclamptic patients are treated. This study aimed to assess the prevalence and determinants of maternal and perinatal outcome of preeclampsia at ARH. METHODS: Our study was a retrospective chart review of preeclamptic patients treated at ARH between September 1, 2016 and September 30, 2018. This study was approved by IRB. RESULTS: Over the study period, the total number of deliveries recorded was 8,502. There were 362 patients with preeclampsia. Most (77.3%) patients had preeclampsia with severity features. Poor maternal outcome was present in 40% of cases while 25% of cases had poor perinatal outcome. The top three poor maternal outcomes reported in this study were, eclampsia (6.6%), maternal death (2.8%), and renal failure (1.1%). Headache (AOR 32.26 95% CI 0.003-0.326 P=.004) and low hemoglobin value (AOR 3.44 95% CI 1.772-6.761 P=.005) were associated with poor maternal outcome. The poor perinatal outcomes were low APGAR score (18.8%), still births (5.8%), and early neonatal deaths (1.1%). Earlier gestational age at diagnosis (AOR 3.19 95% CI 1.762-5.766 P=.0001) was associated with poor perinatal outcome. CONCLUSION: Preeclampsia is a significant problem in Ethiopia. In a resource limited setting where tools are scarce, clinical profile should be taken into consideration for prediction of poor outcome. Owing to the association found in between maternal outcome and hemoglobin, further prospective research is required to identify if anemia was the cause or effect of preeclampsia.

INTRODUCTION: The Ethiopian national cesarean section rate is about 2%, but rates of cesarean delivery (CD) vary widely among population segments suggesting unequal access. Within this context, the aim of this study was to assess the mode of delivery among physicians employed at Ayder Comprehensive Specialized Hospital. METHODS: This is an IRB-approved cross-sectional study. All female physicians who are parous (n = 11) and all male physicians whose spouses are parous (n = 60) were interviewed to evaluate the mode of delivery among them, and assess indications for CD. RESULTS: The CD rate among physicians and their spouses was 46.5% (n=33). 9 out of 10 female obstetrician/gynecologists and male obstetrician/gynecologists' spouses delivered via CD. Of those who had their baby delivered via CD, 22 (67%) believe that the CD was not done for appropriate indications. Only 10 (30%) of these would try labor or allow their spouse to attempt vaginal trial of labor after prior CD. The driving factors for CD among parturient physicians were; lack of trust in the process of intrapartum fetal monitoring (which is used without pattern interpretation), “uncertainty” of outcome of vaginal delivery, fear of labor pain (due to absence of labor analgesia), and managing obstetricians' fear of blame by their colleagues. CONCLUSION: This study revealed a disparity in CD for women who are physicians or physicians' spouses Vs general population. More revealing are the reasons why they underwent CD. Rate of CD may be decreased by winning the confidence of parturients through instituting appropriate intrapartum fetal monitoring and labor analgesia protocols.